defy / blood labs pre trt, thoughts?

[Slater]

My previous post was accidentally deleted so here we go.
Im 50 185 lbs / fit, somewhat...
I had various labs done & my numbers arent tanked. The clinics make it sound like a cure-all / used car salesman....
Im dealing with irritability / moodiness, may be just my personality & has nothing to do with my levels...
Cant sleep to save my life, bed at 8, 9, 11 doesnt matter, im up at 1;30 am & cant go back to sleep afterwards..
memory & train of thought is in the toilet, may be age related...
ed / bedroom performance issues, wasnt what it was....
The first clinic I went to labs were done about 11 am fasted. They did do a free direct test. But also did some sort of calculation to find what my bioavailable usable calculated free testosterone level was & state im a low normal at the 643 total T value along with the 15.2 free test value. They stated they feel I would really benefit from trt....
Since then my defy labs are the lowest.

Just trying to get some thoughts from guys that really understand this stuff as I dont,
I know I can fix some issues & bring-on other issues.
My numbers arent tanked & trying to make the right decision for the right reasons...
I did labs with a local clinic & then due to discussing things with madman & was made aware of Defy I opted to do some additional test & free test, igf1, etc labs & here we are!
The attachment is the recent blood work ordered from defy.
what does the high igf1 mean???
Once again sorry for starting over & would love some thoughts on the matter.
thx
most recent blood draw is bottom attachment
estradiol sens 28.1
igf1 353
test 503
free test 11.2

 

[sammmy]

Your IGF-1 is high for a 50 years old. Depending on the exact test used, it may be in range for an younger individual:

Reference values for IGF-I serum concentration in an adult population: use of the VARIETE cohort for two new immunoassays

Objective Measurement of IGF-I is important in the management of patients with growth hormone disorders. Here we aim to establish normative data for two new IGF-I assay kits based on a large random sample of the French general adult population. Subjects and methods We measured IGF-I in 911...

ec.bioscientifica.com

This has to be investigated by an endocrinologist to rule out Acromegaly and pituitary tumor.

 

[CKO]

From a TRT perspective, your numbers look great.

 

[Systemlord]

Irritability, moodiness, and poor sleep are typical low T symptoms. TRT has greatly improved my sleep which used to be staring at the ceiling all night, now I fall asleep easily and wake up at the appropriate time every morning.

 

[Systemlord]

My numbers arent tanked & trying to make the right decision for the right reasons...

Some food for thought.

Recognizing the True Value of Testosterone Therapy in Health Care

There has been little recognition within the medical community of the health impact of testosterone (T) deficiency (TD), also known as hypogonadism, and the substantial benefits of testosterone therapy (TTh) on health and quality of life despite high-level ...

www.ncbi.nlm.nih.gov

A Critique of the AUA Guidelines on Testosterone Deficiency

The publication of the first American Urological Association (AUA) guidelines regarding the evaluation and management of testosterone deficiency (TD) in 2018 (“

academic.oup.com

Testosterone Controversies and Myths- Lecture by Dr. Mohit Khera

 

[sammmy]

Pathophysiology of Renal Calcium Handling in Acromegaly: What Lies behind Hypercalciuria?

Background:. Hypercalciuria is frequent in patients with acromegaly, but it is unclear how GH/IGF-I regulate renal calcium handling. Elevated fasting plasma cal

academic.oup.com

 

[Slater]

Well, put an email out to my primary doc including the labs requesting referral to an endo....
fingers crossed that im superhuman & its not a tumor...

 

[wannabefan]

You need a Cortisol panel.
Saliva or urine, measured at waking and 3-4 more times over the day. Dutch is one option, Genova another.

I would consider having you’re pituitary gland further examined and rule out a benign issue, regarding IGF-1. What is your fasting insulin level (hopefully <5); was Glucose and other labs fasting?

I also would not be concerned at all with cholesterol panel, unless you have some other known risk factors. HDL isn’t “good” and LDL isn’t “bad”. Get a L-particle, Lipo (a), and ApoB, and consider a coronary calcium scan (super easy and $150), if you have fierce need to know and concerns.

On mood, you could get a urine panel for serotonin, norepinephrine, dopamine, and see where those levels are at.

I don’t frankly see why you’d need TRT if these are baseline numbers. Do you exercise, lift, take creatine, adequate protein intake. I’d watch that potassium (how many avocados, bananas, oranges and kiwis do you eat a day??. Might want to get an aldosterone level checked; it regulates your heart via kidneys, and along with calcium (also high) regulates the electrical impulses of the heart. Your HCt level is also already borderline high range pre-TRT, so you’d likely be a regular blood donor.

 

[Slater]

Use to lift as teen, 20's-30's etc, stopped, Work & life along with back surgery got the best of me & stopped. ive been back at it religiously since September, muscle memory is real as I bounced back fairly quickly, not sure if the elevated igf1 is a factor...
I have 2 sometimes 3 protein shakes daily so at the most 2 bananas a day, no kiwi or oranges, some mixed berries in my protein shakes, most days 1/2 an avocado on canned tuna sandwich on sourdough...
all the labs were fasted, the top 3 were at 11am fasted, bottom attachment was 8am fasted.

 

[Slater]

any history of labcorps making some sort of error on my igf1 test results?
regardless I did forward the info to my primary doc & waiting to here back on a referral...

 

[Slater]

What are thoughts on my free test levels on 11.2???
The entire reason I re-did these labs in the first place...
Assuming 11.2 is on the low-side & can be the reason im feeling the way I do / low T symptoms?

 

[Slater]

anyone???
what is your take on my 11.2 free test value???
culprit to some of my symptoms?

 

[Systemlord]

Assuming 11.2 is on the low-side & can be the reason im feeling the way I do / low T symptoms?

You're not going to get a definitive answer.

culprit to some of my symptoms?

The answer is going to be more scientific, so it's a high probability if by some miracle this lab result is accurate.

We don't know your individual normal range, the normal ranges are "everyone".

Also, the elevated potassium, IGF-1 and calcium are hard to ignore.

 

[Cataceous]

anyone???
what is your take on my 11.2 free test value???
culprit to some of my symptoms?

The direct test is inaccurate and should be ignored. Vermeulen calculated free testosterone (cFTV) based on your first test is about 11 ng/dL, which is a healthy level. If SHBG and albumin are extrapolated to the second test then the cFTV value is about 8 ng/dL, which is borderline. I wouldn't consider conventional TRT with these numbers, but you could try testosterone nasal gel or troches to see if you get any benefits. With your hematocrit already a little high in range you'll want to keep an eye on it.

 

[Nelson Vergel]

I would not get on any hormones with your numbers.

 

[Nelson Vergel]

Im dealing with irritability / moodiness, may be just my personality & has nothing to do with my levels...
Cant sleep to save my life, bed at 8, 9, 11 doesnt matter, im up at 1;30 am & cant go back to sleep afterwards..

I would get checked for sleep apnea. Also, review caffeine intake. What else are you taking?
Is there a possibility that you are stressed or depressed?

 

[Slater]

I would get checked for sleep apnea. Also, review caffeine intake. What else are you taking?
Is there a possibility that you are stressed or depressed?

Ive recently retired so stress is off the table but for 30 years its been a high stress 100 mph career as an engine mechanic at a huge dealership....
Dont handle the stress like I use to. I use to thrive off the stress & made me work faster...
While I was working the anxiety was ridiculous!
Caffeine intake is just 1 cup of black coffee at 6am...
I snore & did a sleep study mid 2022 & tested positive for apnea, use cpap daily & doesnt keep me asleep..
3 weeks ago did a survey with my primary care doc & he was leaning toward depression & the way I answered the survey I tested positive for depression. I started the conversation with dont prescribe sleeping pills or anti depressants...
I explained to him that I dont lack motivation cuz im depressed, I just hit a wall cuz I get up at 130am everyday.
Was re-evaluated just 10 minutes ago from a second dept & he agreed that im not suffering from depression & I did the right think be declining the anti depressants.

 

[Slater]

The direct test is inaccurate and should be ignored. Vermeulen calculated free testosterone (cFTV) based on your first test is about 11 ng/dL, which is a healthy level. If SHBG and albumin are extrapolated to the second test then the cFTV value is about 8 ng/dL, which is borderline. I wouldn't consider conventional TRT with these numbers, but you could try testosterone nasal gel or troches to see if you get any benefits. With your hematocrit already a little high in range you'll want to keep an eye on it.

My first post was accidentally deleted & I stated that the clinic I went to did a calculated usable free testosterone scenario with my values just as you did...
Came-up with the same calculation as you did, an 11 ng...
Said if my testosterone levels were lower like in my first test at 514 I would have gotten an official low T diagnosis of 10.0ng or below...
Madman was making a huge deal about how my testing was done wrong & I need to retest.
He's just ghosting me now on the entire thread & dm's, thought we were all adults here but whatever........
Now that I did it "correctly" & got a 503 test level, a lower free test level, etc...
But few folks are still stating an inaccurate way of testing, should be ingnored, etc...
So why the huge deal about how wrong my first test was!
With a test level of 500, the calculated free test level will be 10 ng or below...
So far from what im seeing from my limited experience all these labs are a total crap-shoot....
Just redid all my labs through Kiaser & everything that was high is within range...
Still waiting on the important result & thats the IGF1. but I have a hunch that will be within range also.
sodium 141 meq/l range 135-145
potassium 4.4 range 3.5-5.0
chloride 102 range 101-111
magnesium 2.0mg range 1.7-2.8
albumin 4.3g range 3.3-4.8
calcium 9.7 mg range 8.5-10.7
parathyroid 28 pg range 15-65
phosphorus 3.1mg range 2.7-4.5
cortisol 10.8 mcg range 3.7-19.4

 

[madman]

My first post was accidentally deleted & I stated that the clinic I went to did a calculated usable free testosterone scenario with my values just as you did...
Came-up with the same calculation as you did, an 11 ng...
Said if my testosterone levels were lower like in my first test at 514 I would have gotten an official low T diagnosis of 10.0ng or below...
Madman was making a huge deal about how my testing was done wrong & I need to retest.
He's just ghosting me now on the entire thread & dm's, thought we were all adults here but whatever........
Now that I did it "correctly" & got a 503 test level, a lower free test level, etc...
But few folks are still stating an inaccurate way of testing, should be ingnored, etc...
So why the huge deal about how wrong my first test was!
With a test level of 500, the calculated free test level will be 10 ng or below...
So far from what im seeing from my limited experience all these labs are a total crap-shoot....
Just redid all my labs through Kiaser & everything that was high is within range...
Still waiting on the important result & thats the IGF1. but I have a hunch that will be within range also.
sodium 141 meq/l range 135-145
potassium 4.4 range 3.5-5.0
chloride 102 range 101-111
magnesium 2.0mg range 1.7-2.8
albumin 4.3g range 3.3-4.8
calcium 9.7 mg range 8.5-10.7
parathyroid 28 pg range 15-65
phosphorus 3.1mg range 2.7-4.5
cortisol 10.8 mcg range 3.7-19.4

Have no clue who deleted your previous thread.

I told you to get your blood work done using accurate assays, TT (LC/MS-MS) let alone FT (Equilibrium Dialysis or Ultrafiltration), especially in cases of altered SHBG and not the direct immunoassay that you had done.

I gave you the link for the panel.

Testosterone, Free (Dialysis) and Total, MS

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

All you needed to do was up the $44 for the most accurate assays.

Yet you went and retested using the same FT assay!

Again I would not rely on the direct immunoassay, especially in cases of altered SHBG.

You posted a TT 643 and 500s yet no SHBG value for your second test.

Forget what your results were when you tested at 11 am as I already told you that it is critical when testing TT/FT/BAT it needs to be done in the early AM in a fasted state let alone using the most accurate assays.

If you want to rely on the calculated method then make sure when getting blood work done that you have TT (LC/MS-MS), SHBG, and albumin.

Just to be clear I already gave you advice that you did not follow.

If you want to rely on your most recent labs and jump in head first then go nuts.

Do what you feel is best for you.

 

[madman]

My first post was accidentally deleted & I stated that the clinic I went to did a calculated usable free testosterone scenario with my values just as you did...
Came-up with the same calculation as you did, an 11 ng...
Said if my testosterone levels were lower like in my first test at 514 I would have gotten an official low T diagnosis of 10.0ng or below...
Madman was making a huge deal about how my testing was done wrong & I need to retest.
He's just ghosting me now on the entire thread & dm's, thought we were all adults here but whatever........
Now that I did it "correctly" & got a 503 test level, a lower free test level, etc...
But few folks are still stating an inaccurate way of testing, should be ingnored, etc...
So why the huge deal about how wrong my first test was!
With a test level of 500, the calculated free test level will be 10 ng or below...
So far from what im seeing from my limited experience all these labs are a total crap-shoot....
Just redid all my labs through Kiaser & everything that was high is within range...
Still waiting on the important result & thats the IGF1. but I have a hunch that will be within range also.
sodium 141 meq/l range 135-145
potassium 4.4 range 3.5-5.0
chloride 102 range 101-111
magnesium 2.0mg range 1.7-2.8
albumin 4.3g range 3.3-4.8
calcium 9.7 mg range 8.5-10.7
parathyroid 28 pg range 15-65
phosphorus 3.1mg range 2.7-4.5
cortisol 10.8 mcg range 3.7-19.4

Keep in mind that your estradiol, hemoglobin/hematocrit are already on the higher end and it is a given that your levels will be driven up on exogenous T.

Good chance you will end up struggling with this!

If you already have sleep apnea then it may very well be a bumpy ride for you.